Introduction Acoustic radiation force impulse elastography (ARFI) and Transient elastography (TE) are noninvasive methods of measuring liver stiffness (LS) and spleen stiffness (SS). They were proposed as non-invasive predictors of portal hypertension in patients with HCV-related cirrhosis, a highly prevalent disease in Egypt. This is the first egyptian study aimed to validate the reliability of liver and spleen stiffness measured by ARFI and other non-invasive methods as non-invasive predictors for presence of esophageal varices (EV).
Methods This cross-sectional study included 200 patients (mean age was 54.9±8 years) with HCV-related advanced fibrosis (METAVIR score ≥F3) diagnosed by FibroScan® (≥ 9.5 kilopascal) including Child Turcotte Pugh class A/B liver cirrhosis; 82/18%. Demographic, clinical, biochemical, endoscopic and ultrasonographic data were collected. LOK index and FIB-4 score were calculated. Liver and spleen stiffness were assessed by 10 ARFI measurements, both in the liver and in the spleen; median values were calculated, expressed in m/sec. The accuracy of these diagnostic methods in diagnosing EV was evaluated on the basis of area under receiver operating characteristic (AUROC) curves.
Results Liver stiffness measurement by FibroScan® revealed F4 in 95.5% and esophageal varices were present in 90 patients (39 Grade I, 30 Grade II, 18 Grade III, 3 Grade IV). Spleen longitudinal diameter (cutoff value 14.85 cm), splenic vein diameter(cutoff value 7.9 mm); platelets to spleen diameter ratio (cutoff value 960), LOK index (cutoff value 0.62)and FIB-4 score (cutoff value 2.81) were the best parameters among all the ultrasonographic and biochemical parameters for prediction of esophageal varices; AUROC 0.79, 0.76, 0.76, 0.74 and 0.71, respectively. Using ARFI, SS had better diagnostic performance than LS with cutoff value of 3.25 m/sec and 2.61 m/sec; AUROC =0.76 and 0.70, respectively. Moreover, the calculation of simple prediction models including LS and/or SS improved the reliability of ARFI for the prediction of esophageal varices; (Spleen longitudinal diameter × Splenic vein diameter × SS) and (LS× SS / Platelets/Spleen diameter ratio) with AUROC = 0.85 and 0.83 respectively.
Conclusion Liver stiffness and spleen stiffness represent a non-invasive reliable tool for the prediction of clinically significant portal hypertension as evident by the presence of esophageal varices in chronic liver disease patients.
Disclosure of Interest M. Abdelbary: None Declared, S. Kamal, None Declared, A. Albuhairi: None Declared, A. Khairy Grant/research support from: ABBVIE, Speaker bureau with: Astra Zeneca, N. Zayed Grant/research support from: ABBVIE, A. Yosry Consultant for: Roche, Janssen, Gilead, MSD, Speaker bureau with: Roche, Janssen, Gilead, MSD